Purpose
To determine the relationship between preoperative patient expectation and postoperative
satisfaction and overall patient-reported outcome (PRO) of patients undergoing hip
arthroscopy for femoroacetabular impingement syndrome.
Methods
Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome completed
the validated Hip Preservation Surgery Expectations Survey (21 questions; 0-100 range),
as well as multiple PROs before surgery. High expectation was defined as an expectation
score greater than 1 standard deviation above the mean. Patients with osteoarthritis,
dysplasia, and those having undergone previous hip surgery were excluded. At 1 year
postoperatively, patient visual analog scale (VAS) satisfaction, VAS pain, and PROs
were assessed. Univariable and multivariate analyses were performed.
Results
One-hundred fifty-three subjects (mean age 34.4 ± 12.6 years, female: 114 [71.3%],
body mass index: 25.9 ± 5.3 kg/m2) participated. The mean expectation score was 84.5 ± 12.3. Significant correlations
between high expectation scores (>96.7) and achieving the minimal clinical important
difference (MCID) for modified Harris Hip Score (mHHS; r = 0.339; P = .043) and patient acceptable symptomatic state (PASS) for Hip Outcome Score-Activities
of Daily Living Subscale (HOS-ADL; r = 0.207; P = .032) were observed. There were no significant correlations between high expectation
scores and preoperative or postoperative PROs or patient satisfaction scores. χ2 analysis demonstrated patients with greater expectations had increased rates of reaching
MCID mHHS (92.3% vs 74.7%; P = .08), PASS mHHS (85.7% vs 69.7%; P = .046), and PASS HOS-ADL (93.8% vs 67.4%; P = .031).
Conclusions
High preoperative expectation is associated with increased rates of MCID/PASS achievement
on mHHS and increased rate of PASS achievement on HOS-ADL. Preoperative expectations
did not have an impact on Hip Outcome Score-Sports Subscale; however, patients with
high preoperative expectations also have a high baseline Hip Outcome Score-Sports
Subscale. In addition, preoperative expectations are not associated with postoperative
VAS satisfaction scores.
Level of Evidence
III; non-randomized cohort, therapeutic.
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References
- The quality of care. How can it be assessed?.JAMA. 1988; 260: 1743-1748
- Conceptualisation of patient satisfaction: A systematic narrative literature review.Perspect Public Health. 2015; 135: 243-250
- Patient expectations of arthroplasty of the hip and knee.J Bone Joint Surg Br. 2012; 94: 974-981
- How do the expectations of patients compare with their surgeons regarding outcomes of periacetabular osteotomy?.J Hip Preserv Surg. 2018; 5: 378-385
- Hip preservation surgery expectations survey: A new method to measure patients' preoperative expectations.Arthroscopy. 2017; 33: 959-968
- Evidence of validity for the hip outcome score.Arthroscopy. 2006; 22: 1304-1311
- Hip arthroscopy: Patient assessment and indications.Instr Course Lect. 2003; 52: 711-719
- Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.J Bone Joint Surg Am. 1969; 51: 737-755
- The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): An international consensus statement.Br J Sports Med. 2016; 50: 1169-1176
- A review of imaging modalities for the hip.Curr Rev Musculoskelet Med. 2013; 6: 226-234
- Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: A prospective randomized study.Arthroscopy. 2013; 29: 46-53
- A systematic approach to the plain radiographic evaluation of the young adult hip.J Bone Joint Surg Am. 2008; 90: 47-66
- The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.J Bone Joint Surg Br. 2002; 84: 556-560
- The use of double-loaded suture anchors for labral repair and capsular repair during hip arthroscopy.Arthrosc Tech. 2012; 1: e213-e217
- Routine complete capsular closure during hip arthroscopy.Arthrosc Tech. 2013; 2: e89-e94
- Improved outcomes after hip arthroscopic surgery in patients undergoing T-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: A comparative matched-pair analysis.Am J Sports Med. 2014; 42: 2634-2642
- The influence of pain in other major joints and the spine on 2-year outcomes after hip arthroscopy.Arthroscopy. 2018; 34: 3196-3201
- Preoperative symptom duration is associated with outcomes after hip arthroscopy.Am J Sports Med. 2019; 47: 131-137
- Time required to achieve minimal clinically important difference and substantial clinical benefit after arthroscopic treatment of femoroacetabular impingement.Am J Sports Med. 2018; 46: 2601-2606
- Preoperative outcome scores are predictive of achieving the minimal clinically important difference after arthroscopic treatment of femoroacetabular impingement.Am J Sports Med. 2017; 45: 612-619
- Hip arthroscopy for atypical posterior hip pain: A comparative matched-pair analysis.Am J Sports Med. 2017; 45: 1627-1632
- Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions.J Orthop Surg Res. 2015; 10: 24
- The patient acceptable symptomatic state for the modified Harris hip score and hip outcome score among patients undergoing surgical treatment for femoroacetabular impingement.Am J Sports Med. 2015; 43: 1844-1849
- Clinically meaningful improvements after hip arthroscopy for femoroacetabular impingement in adolescent and young adult patients regardless of gender.J Pediatr Orthop. 2018; 38: 465-470
- A prospective study of the association of patient expectations with changes in health-related quality of life outcomes, following total joint replacement.BMC Musculoskelet Disord. 2014; 15: 248
- Reproducibility, validity, and responsiveness of the hip outcome score in patients with end-stage hip osteoarthritis.Arthritis Care Res (Hoboken). 2012; 64: 1770-1775
- Do female athletes return to sports after hip preservation surgery for femoroacetabular impingement syndrome? A comparative analysis.Orthop J Sports Med. 2019; 7 (2325967119831758)
- Athletes do better after FAI arthroscopic treatment in male population.J Orthop Surg (Hong Kong). 2018; 26 (2309499018760111)
- Pre-operative thresholds for achieving meaningful clinical improvement after arthroscopic treatment of femoroacetabular impingement.Orthop J Sports Med. 2016; 4
- Using evidence-based algorithms to improve clinical decision making: The case of a first-time anterior shoulder dislocation.Sports Med Arthrosc Rev. 2013; 21: 155-165
Article Info
Publication History
Accepted:
June 13,
2019
Received:
December 4,
2018
Footnotes
See commentary on page 3259
The authors report the following potential conflict of interest or source of funding: S.J.N. reports non-financial support from Allosource, other from American Journal of Orthopedics, other from American Orthopaedic Society for Sports Medicine, non-financial support from Arthrex, other from Arthroscopy Association of North America, non-financial support from Athletico, non-financial support from DJ Orthopaedics, non-financial support from Linvatec, non-financial support from Miomed, personal fees from Ossur, non-financial support from Smith and Nephew, personal fees and non-financial support from Springer, and non-financial support from Stryker, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Surgeons Should Not “Underpromise” to “Overdeliver”: High Preoperative Patient Expectations Correlate With Improved Orthopaedic Surgical OutcomesArthroscopyVol. 35Issue 12
- PreviewDespite our understanding of patient-specific, anatomic, and surgical factors that can influence surgical outcomes, there remains a significant amount of variability in patient satisfaction and outcome after any orthopaedic surgical procedure. This variability is in large part due to psychosocial factors. There is a growing volume of literature demonstrating the importance of psychosocial factors to include anxiety, depression, attitudinal factors, expectations, patient-perceived control, self-efficacy, knowledge, and expectations.
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